Page Contents:

Newborn Baby Care, Written by, Danielle Bishoff- Australia

Vitamin K and Newborn Treatments, Written by, Danielle Bishoff- Australia

Vitamin K Injection at Birth, Written by, Claire Hall, Midwife - Australia



NEWBORN BABY CARE

Written by Danielle Bishoff- Australia


Breathing:

• Normal newborn breathing is irregular - it can be fast, then slow, then deep, then shallow. The average newborn takes about 40-60 breaths per minute. 
• Your baby may sound a bit congested after birth, which is normal after going from a fluid filled environment to an air-filled one. Your baby may make funny sounds…snorting, snoring, gurgling. This is normal as the mucous is cleared from the lungs. A baby can only clear the airway by coughing or sneezing and cannot sniff, swallow, or blow mucous like we can. 
• What is important is that the baby is pink, warm, and alert.

 
Warmth:

• Your baby needs skin to skin human contact. Newborn babies are not able to regulate their body temperature, so it is up to you to make sure he is not too warm or cold. 
• When your baby is skin to skin on your chest, your breasts will change their temperature to keep your baby perfectly warm. 
• For the first few days it can be normal for the baby’s hands and feet to have a slightly blue tinge, but make sure that the skin is warm to the touch and not chilled. The general rule of thumb is to dress the baby in the same amount of clothing you are comfortable in and then add one layer. 
• Skin to skin contact is always ideal.

 
Urinating:        

• Your baby should urinate within the first 24 hrs. Until your milk comes in, generally between 2-5 days postpartum, wet diapers may not be too frequent. 
  
• After 2-3 days after birth, the baby should have 6 or more wet nappies per day. It can be difficult to tell with absorbent disposable nappies. If you are concerned that the baby is not peeing, place a washcloth in the nappy. The urine should be clear or pale yellow. 
  
• Sometimes, during the first week, babies may pass uric acid crystals. This will look like a red or brickdust stain in the diaper and is generally a normal occurrence.
  

 
Bowel Movements:

• Your baby’s first bowel movements are a black, tarry sticky substance called meconium. This should be passed within 24 hrs of birth and can be washed off with warm water. 
  
• Applying olive oil to the baby’s bum can also help to make the meconium stick less to the skin. 
• The stools gradually change to a green-brown, and then the normal breastfed infants poo will look like mustard with a bit of cottage cheese curdles. 
• A baby can have a bowel movement after each feeding or much less frequently. There are many variations of normal. If your baby has not had a bowel movement in 4-5 days, or there is a sudden change in your baby’s pattern, or the baby seems ill or distressed, consider calling your care provider. 
• Read the section on jaundice to see how often a baby with jaundice should be pooping.

 
Cord Care:

• The cord usually falls off around 4-14 days after birth. 
  
• Keep the baby’s nappy folded down to prevent irritation. You can clean around the cord with a warm washer and let it air dry. If it smells strongly, clean it more often with a cotton tip. 
• Goldenseal root powder also works wonders for drying out a cord and preventing infection (sprinkle a pinch of powder on the cord 3 times a day). 
• Make sure the cord is not too moist and gets enough exposure to air. 
• Call your care provider if the cord is oozing green pus or if the skin is red or inflamed.

 
Jaundice:

• Most babies are born with extra red blood cells that are broken down and are eliminated from the body in the first week of life. Bilirubin is a byproduct of this process and is a yellow pigment. Jaundice results when excess bilirubin accumulates in the blood. 
  
• More than half of all newborns become jaundice within the first week of life. This is temporary and normal and usually resolves without treatment. Offering as much breastmilk as the baby will take will help rid the body of bilirubin. 
• The timing of when jaundice occurs is very important: contact your care provider if your baby is jaundiced at birth or within the first 24 hrs, or if jaundice suddenly appears after the fifth day. 
• Be aware of timing, severity, and location of jaundice (face? trunk? down the arms and legs?) Normal jaundice happens starting on the second to fifth day of life. Lots of nursing and having your baby naked in indirect sunlight 20 minutes per day will help normal jaundice resolve more quickly. 
• If your baby is sleepy or lethargic you will need to be proactive about waking and stimulating to nurse often enough. 
• Jaundice normal peaks and then declines and is usually gone within 2 weeks. Less commonly, breastfed newborns have prolonged jaundice that lasts into the first few months of life. This is generally not a cause for concern (depending on the severity of the jaundice) when there are no other signs of illness or distress. 
• Please call your care provider if your baby is jaundiced and too lethargic to nurse frequently or not pooping at least 2 times a day.

 
Skin:

• Your baby’s skin may be dry and peeling within the first few weeks after birth, which is normal as the baby switches from water skin to air skin.
• Introducing anything other than natural products to the skin often results in a reaction or irritation. 
• The baby may develop what is commonly called Normal Newborn Rash (small red bumps with a white or yellow tip) or its many variations. 
• Watch for any postules that break open to reveal pus; contact your care provider.

Eyes:

• Sometimes babies may have a red spot or two in the eyes caused by blood vessels which broke during birth. This will go away on its own. 
• Babies tear ducts do not create tears right away, which can allow for bacteria to grow. The eyes may get a yellow green discharge or become a little crusty; you can wipe them with a wet cotton ball. 
• Breastmilk is antibacterial and makes a handy eyewash and prevents further discharge! Another way to help your baby’s tear ducts empty is to massage them: Wash your hands and massage the eyelids gently in a circular motion from the outside of the eye towards your baby’s nose. This is easiest when your baby is very sleepy and can be done several times a day. 
• Most often, baby’s eyes are completely fine and there is no need for any of the above. Just be sure to watch out or any redness, swelling or discharge, particularly if you have a known history of gonorrhea or chlamydia.

 
Breasts and Genitalia:

• You may notice that your baby’s breast tissue may seem very prominent in the first few weeks. Some may even have a drop or two of pale white secretions, called “witches milk”. This is due to the hormones transferred to the baby in the womb and will go away as time progresses. The same hormones may cause the scrotum to be enlarged or the labia to be swollen. 
• Your baby girl may pass some mucous and possibly some blood from her vagina for up to a few days (another effect of the hormones). This is normal, temporary, and there is no cause for concern.

 
Bathing:

• Your baby does not necessarily need a bath right away, and too frequent bathing can dry out the skin. 
• Spongebaths can help clean the areas behind the ears and in the folds of the neck where breastmilk collects. 
• Again, try to avoid any synthetic products in order to avoid irritation or skin reactions.

 
Gas and Colic:

• Gas is not always preventable, but there are many things you can do to help. 
• Gently but firmly massaging your baby’s belly in a clockwise, circular motion can help gas bubbles move through. 
• Bicycling or rolling your baby’s legs up to his chest can bring gas out. 
• You can also give your baby a warm bath to help relax the muscles. 
• Crushed fennel and caraway seed tea can be very helpful: a few teaspoons for the baby or cups of tea for yourself. 
• Spitting up is a common occurrence and does not mean that your baby is eating too much; babies are incapable of overeating. 
• Seek help if the colic persists or is accompanied by persistent vomiting, diarrhea, constipation, or absence of urine. 

Danielle Bishoff 

Email: sunshinecoast@homebirth.org.au 

 

VITAMIN K AND NEWBORN TREATMENTS

Written by Danielle Bishoff- Australia


Vitamin K

Vitamin K is a naturally occurring substance that affects blood coagulation in the body. At birth, the gut of a newborn is virtually sterile. It is the introduction of micro flora through the diet that makes the body create stores of vitamin K, which can then be used to control bleeding. Babies of well-nourished women who are nursing well will develop sustainable vitamin K by 3 or 4 days of life. Babies who are given an injection of vitamin K at birth will theoretically have enough to prevent Vitamin K Deficiency Bleeding (VKDB).

Treatment Options

Vitamin K is offered to newborns at birth in the form of an injection into the thigh. In the healthy, breastfed infant, the incidence of VKDB occurs in approximately 5-10 out of every 100,00 births. The incidence of VKDB after an injection at birth is approximately 1 out of 400,000. Clearly, prophylactic treatment is a very effective preventative measure IF the baby is vulnerable to lowered levels of vitamin K (which presumably occurs at about the same rate of 5-10 out of 100,000). Two factors have proven to increase the risk of VKDB: prematurely and traumatic birth.

VKDB usually occurs around 3-5 days after birth and manifests in several ways:

• Bleeding from the nose, mouth, ears, umbilical cord, urinary tract, or rectum.
• Appearance of bruises without obvious trauma.
• Black, tarry stool after me conium has cleared.
• Bleeding after a wound that lasts longer than 6 minutes.
• Paleness, jaundice, glassy-eyed look, high-pitched crying, loss of appetite, fever, vomiting, irritability, seizures.
• Pathological jaundice, especially when associated with dark urine.

Other things to consider when deciding on treatment options:

• It is largely unknown exactly WHY newborns have minimal levels of vitamin K. Theories about the heart and liver show interesting points. After birth, the baby’s heart must switch from fetal to newborn circulation. This means that a valve in the heart has to redirect blood flow; it has to fuse into a new part of the heart. Perhaps the variation in clotting factors helps with this process. Also, the newborn liver is very immature. Vitamin K creates a quality and quantity of red blood cells that is inevitably very taxing on the liver. The question remains: why are breastfed babies naturally deficient?
• The dosage currently recommended is based on a risk/benefit rationale, which indicates that the negative effects of increased levels of vitamin K in the newborn are not only recognized but are also greatly unknown.

While VKDB occurs rarely, when it does occur it is often a very serious matter. Self-education and investigation into current trends and research can be very helpful.

Newborn Screening  

Also called the “PKU” test, newborn screening    tests for a variety of metabolic disorders called Inborn Errors of Metabolism. There are dozens of these disorders, most of which can be treated with dietary changes or other therapies. Most of these conditions are not inherited, although a family history of     unexplained problems in infancy or childhood may be significant.

How is the test taken?

The screening tests consist of obtaining blood from the baby’s heel. This is done twice within the first couple weeks after birth (the timing of each test depends on specific conditions being tested for that occur at different times). The blood is obtained by using a fine needle to poke the heel, which unfortunately will usually bring discomfort to the baby. There are many ways to soften the experience and bring as little pain to the baby as possible.

Does the test have to be done?

As with many aspects of your care, this is also one of your choices. If you have strong feelings against the test, I would recommend further investigation into current research of rates of occurance, predisposing factors, and warning signs of different disorders. Most conditions are symptom free for the first 24 hours of life, and many of the conditions prompt a reaction in the body only after certain proteins have been ingested. One of the strongest arguments for doing the screen is that many conditions are symptom free for quite some time; once symptoms occur, irreversible damage will have occurred that could have been treated if caught in time.

What happens there is a positive result?

Due to the high number of conditions the test screens for, there are many answers to this question that range from simple dietary changes to highly supportive medicalized care. It just depends on the individual condition. Any positive result indicates the need to collaborate with the medical community.

The screening test varies from state to state; different places test for slightly different conditions. Since there is no one cohesive test, a negative result is reassuring but not conclusive. Generalized signs and symptoms to watch for include:

• Peculiar body odor or smell of urine: musty, burnt sugar, maple syrup, cheesy, brewery, rancid butter, rotten cabbage, stale fish, cat’s urine.
• Seizures,
• Persistent vomiting.
• Respiratory distress.
• Lethargy.
• Low body temperature.

Danielle Bishoff  

Email: sunshinecoast@homebirth.org.au



Vitamin K Injection at Birth

Written by Claire Hall, Midwife - Australia 


Vitamin K is a fat-soluble vitamin involved in blood clotting(1). It is also involved in bone formation and repair, even decreasing the incidence or severity of osteoporosis.(11) There are two naturally occurring forms of vitamin K – in green leafy vegetables and bacteria make a range of vitamin K forms in the human gut.(2)

Why do they want to give it to my baby?

All babies are born with low levels of vitamin K as compared with adults. Medical literature calls this a “relative vitamin K deficiency”.(3) Babies are also born with a sterile gut, and the “good” bacteria need time (about 6months) to build up to a sufficient level of vitamin K. In 1894, the term “Haemorrhagic Disease of the Newborn” (HDN) was first used to describe unexpected bleeding in the newborn baby. Since 1999, most use the term “Vitamin K Deficiency Bleeding” (VKDB).  

What are the statistics?

VKDB is classified into early, classical and late, based on the age of the baby when the bleeding occurs. 

1.    Early VKDB – occurs on the first day of life and is confined to babies born to mothers who have received medications that interfere with vitamin K metabolism (eg drugs for epilepsy, barbiturates, warfarin etc) The reported incidence is 6 – 12% of mothers who take such drugs and receive no vitamin K prophylaxis. (3)

2.    Classical VKDB – occurs from 1 – 7 days after birth and is more common in infants who are unwell at birth or who have delayed onset of feeding. Bleeding is usually from the umbilicus, gastrointestinal tract, skin punctures, surgical sites and uncommonly in the brain. The reported incidence is variable, from 0.25 – 1.5% (most recent studies state 0.44%) If “most” babies are unwell or have delayed onset of feeding then the figures for “well” babies are 0.13 – 0.75% at the very highest. The National Health Research Council state that “There is considerable uncertainty about the true rates of classical VKDB”  (3)

3.    Late VKDB – occurs from 8 days to 6 months after birth, with most occurring at 1 – 3 months. It is almost completely confined to fully breast fed babies. About ½ of the babies have underlying liver disease or other malabsorptive states. The reported incidence is 0.005 – 0.02%. (Therefore it can be assumed that the incidence in babies who have no apparent underlying disease is 0.0025 – 0.01%) Of this number, 30 – 50% have serious intracranial haemorrhage. Other sites of bleeding include skin, gastrointestinal tract, umbilicus or surgical sites. About 30% have minor bruising or other signs prior to a serious bleed.(3)

What might indicate my baby has an increased risk of VKDB?

· Maternal medications that interfere with vitamin K metabolism, such as anticonvulsants, anticoagulants, barbiturates and antibiotics. Maternal vitamin K supplementation that is administered prenatally may prevent this form of VKDB. If you take any medication, consult with your GP as to whether it inhibits Vitamin K synthesis and metabolism.

· If your baby received antibiotics, these antibiotics can inhibit the formation of “good” healthy bacteria in the baby’s gut that produce vitamin K.

· Liver disorders that prevent the normal production of vitamin K in the newborn's gut -symptoms tend to appear slowly. These include prolonged jaundice, pale stools and enlarged liver and spleen.

· Other risk factors include diarrhoea, hepatitis, cystic fibrosis (CF), celiac disease, and alpha1-antitrypin deficiency.

When and how do they recommend  it be given to my baby?

The NHMRC recommend that it be given to all newborn infants at birth. At present, over 95% of 260 000 newborn babies in Australia receive an intra muscular injection of vitamin K, and most of the remainder receive vitamin K orally.(3)  

What factors do I need to consider  before giving my baby vitamin K?

· Considering the fact that allbabies have a low level of vitamin K when born, (as compared to adults), could this be beneficial, rather than a danger? If all babies have a low level, then why is this not considered normal, but deficient (and therefore in need of a drug to “fix” it)? The levels of all other vitamins and minerals in our bodies are measured by what is normal to the majority of a healthy population. Why is it different for vitamin K?

· There are no randomised-controlled trials that adequately address the effectiveness of prophylaxis in preventing VKDB. But statistics do show that 73% of babies who get VKDB have received Vitamin K prophylactically. This hardly indicates a successful preventative treatment. Why do we continue to give it routinely?

· The very highest statistics we can honestly use for apparently healthy babies to suffer classical VKDB is 0.13 – 0.75%, and late VKDB 0.0025 – 0.01%. I know of no other disease where the entire population receives the treatment when the occurrence rate is so low

· Other causes for this unexplainable bleeding in babies is an unexplored area in the medical research field. Why?

·   Is it a co-incidence that this “unexplained bleeding” came to the notice of the medical profession at the height of the “medically managed birth”? (ie high levels of intervention, early cord clamping and other deviations from the natural, physiological processes?)(9)

· The World Health Organisation recognises that some countries have a policy of administering Vitamin K but they state, “the evidence for routine administration of vitamin K to all newborns to prevent the relatively rare haemorrhagic disease of the newborn is still lacking.” (8)The WHO works on health issues for those who often have very poor nutrition, why is it that they think there is insufficient evidence to routinely administer vitamin K? Could it be that the rates of VKDB in countries that allow a more natural, physiological approach to birth are even lower than the statistics quoted in this article?(8) Is it a co-incidence that those countries that recommend a routine dose of vitamin K be given to all newborn babies are those countries rich enough to a) medically manage most births, and b) afford the vitamin K?

· The body does not readily utilise synthetic vitamins and minerals. (such as what is administered to your baby)

· It is not known how the Vitamin K that is injested is absorbed, metabolised or used by the body.

· The injection itself poses an issue – firstly, the pain inflicted on a newborn; and secondly, an injection creates an avenue of infection for a newborn with an immature immune system in an environment that contains the most dangerous germs, (hospital). There is no oral form of vitamin K for babies. The injectable form is used as an oral medication, despite the lack of credible research as to how it is absorbed.

· According to the company who makes the Vitamin K for injection, “Studies of carcinogenicity, mutagenesis or impairment of fertility have not been conducted with Vitamin K1 Injection”

· The question of maternal diet and how much it affects levels and production of vitamin K lies unanswered. The studies that show diet has no effect are highly inadequate in the control and consideration of many variables that would affect dietary absorption. Surely exploring this avenue seems to be the obvious path, yet research is very limited and the methods questionable.

·   There is an association between traumatic birth and VKDB.(9)

·   Published in “Disease in Childhood - Fetal and Neonatal”2003; 88:F80, .  E Hey (who is pro giving vitamin K prophylaxis to all babies) writes  "Policies for giving babies vitamin K prophylactically at birth have been dictated, over the last 60 years, more by what manufacturers decided on commercial grounds to put on the market, than by any informed understanding of what babies actually need, or how it can most easily be given.” (7)

 
Before you choose to inject your Baby with a drug (yes “vitamins” are drugs, particularly synthetically produced ones that contain preservatives and other ingredients) you really need to weigh the following questions -

1. Has science proven that it is necessary?
2. What harm is being done by changing the low levels of vitamin K that Babies were designed to have?
3. What role does medically managed birth have in causing VKDB?
4. Do I or my Baby have a condition, or take medication that puts my Baby at higher risk and therefore alter my decision about receiving vitamin K?
5. Do the risks of Vitamin K Deficiency Bleeding outweigh the risk of a drug reaction, possible infection, or some as yet unknown effect in later life?    

References:

1.    Brody T. “Nutritional Biochemistry”. 2nd ed. San Diego: Academic Press; 1999.

2.    Booth SL, Suttie JW. “Dietary intake and adequacy of vitamin K”. J Nutr. 1998;128(5):785-788.  (PubMed)

3.    “Joint statement and recommendations on vitamin K administration to newborn infants to prevent vitamin K deficiency bleeding in infancy.” National Health and Medical Research Council; 2000

4.    Pamphlet “Vitamin K For Newborn Babies – Information For Parents”; National Health and medical Research Council; 2000

5.    Schubiger G, Stocker C, Banziger O, Laubscher B, Zimmermann H.; “Oral vitamin K1 prophylaxis for newborns with a new mixed-micellar preparation of phylloquinone: 3 years experience in Switzerland.”  Department of Paediatrics, Kinderspital, Luzern, Switzerland. kispiluzern@bluewin.ch

6.    Arteaga-Vizcaino M, Espinoza Holguin M, Torres Guerra E, Diez-Ewald M, Quintero J, Vizcaino G, Estevez J, Fernandez N; “Effect of oral and intramuscular vitamin K on the factors II, VII, IX, X, and PIVKA II in the infant newborn under 60 days of age”; Rev Med Chil. 2001 Oct;129(10):1121-9 [Article in Spanish]http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12598491

7.    www.gentlebirth.org/archives/vitktop.html

8.    Wickham Sara; “Postnatal Vitamin K”; www.withwoman.co.uk/contents/info/vitamink.html

9.    www.vaccination.inoz.com/VitaminK.html

10.   Suttie JW. “The importance of menaquinones in human nutrition”. Annu Rev Nutr. 1995;15:399-417. (PubMed)

11.   www.anyvitamins.com/vitamin-k-info.htm



Other Resources:

www.healthinsite.gov.au/topics/Vitamin_K_for_Babies

www.cochrane.org/reviews/en/ab002776.html

Mercer JS, Vohr BR, McGrath MM, Padbury JF, Wallach M, Oh W. “Delayed cord clamping in very preterm infants reduces the incidence of intraventricular hemorrhage and late-onset sepsis: a randomized, controlled trial.” Pediatrics. 2006 Apr;117(4):1235-42.    


Claire Hall, Midwife - Australia

Email: charisbirthsupport@bigpond.com